Have we stepped up to take the TB-HIV duo head on?

While the world took some time off to commemorate World AIDS Day on the first of December 2017, themed “Right to health” by the World Health Organization it is clear that the strong collaboration between tuberculosis (TB) bacteria and Human Immunodeficiency Virus (HIV), is still devastating human lives, and a strongly bonded human response to this deadly duo has not yet been fully-formed.
While it is exciting to note the milestones so far attained in the HIV
response programs, the hard work may as well go to waste if the
milestones are not cemented through intense collaboration and customized
responses in the unique settings.

Ms Mavis Nxumalo, an HIV activist in Swaziland, working at the Ministry of Health, stood in front of the congregation on a December Sunday morning, reminding everyone that while we remember those whom we have lost to HIV related illnesses, we need to;“….be responsible for our actions, protecting our loved ones (spouses and the unborn children), go and test and know your HIV status and avoid stigma.” In this mouthful of a statement, it would have been essentially pertinent to highlight the ‘tag-along’ TB and how to prevent it. Instead, the rendition ended with a reminder to light a candle in memory of the departed ones, followed by other church announcements. In essence, the double epidemic of TB-HIV is still being addressed individually, keeping us many steps behind in our efforts to prevent the march of TB and HIV, and far too many lives are being lost.

An otherwise healthy looking 38 years old Thabiso Mthetwa (name changed), was recently diagnosed with HIV. On speaking to him during a workplace wellness outreach program, he said; “I have not experienced any out of the ordinary health concerns and I am still trying to establish when I was infected”. He thus did not see any need to get a TB screening test done through sputum examination. He became evasive on being interviewed and was clearly distressed. However he agreed to be referred to his doctor on this issue. His reaction was an indicator that the general population still expects only a sickly person to test positive for HIV and that the link between HIV and TB is still vague, though most people living with HIV (PLHIV) are better informed.

In the WHO publication this year, the key messages to achieve universal health coverage were listed as: (i) Leave no one behind, (ii) Integrate HIV, TB and hepatitis services, (iii) Provide high quality services and access to affordable care for PlHIV (iv) Have a robust HIV response leading to stronger systems ( www.who.int/campaigns/aids-day/2017/event/en/)

With due respect and acknowledgement to the experts that penciled these key messages, that will guide and influence programming in healthcare and HIV responses in countries all over the world, it suffices to say that PLHIV still get flu, malaria, get hurt in accidents and also have other healthcare problems that a person without HIV deals with. So integrated high quality healthcare services and multidisciplinary affordable care for all should be the hallmark of universal health coverage. In this way, we will not leave anyone behind. In high-burden countries if the focus is on whole-population health, with affordable quality services for all, it will not only address the issues of missed opportunities, but also reduce stigma. Care and treatment should be provided to those who have the disease, and prevention measures to those who need it. Dr Linda Gail-Bekker, President of International AIDS Society: and Professor of Medicine and Deputy Director, Desmont Tutu HIV Center, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa said that a city like Cape Town reports more TB cases than the whole of USA. high-burden countries. The care systems and response programmings can therefore not be standardised. They have to be suited to local realities.

At the end of the day, all people are exposed to the TB causing bacteria that mostly affect the lungs. It is spread from person to person through the air that we breathe, especially by cough, spit or sneeze from an actively infected person. The main symptoms of TB include coughing, fever, night sweats and weight loss and these may remain mild for an extended period within which, the sick person can potentially infect 10-15 other people through close contact if he/she does not seek medical attention.

In 2010 came the rapid molecular test Xpert MTB/RIF, which expedited diagnosis of TB to within two hours and could also detect resistance to rifampicin. TB is a treatable and curable disease. Concerted efforts at global and country level have saved an estimated 53 million lives between 2000 and 2016. But we still have a long way to go before there is a complete stop to unnecessary loss of lives from TB and HIV.